Open and Closed Fractures and How to Treat Them

There are two classifications of fractures, closed fractures and open
fractures. Closed fractures include any fracture where the bone does not
penetrate the skin (the skin stays closed). In such instances, proper treatment
includes immobilizing the fracture and seeking medical help.

Open fractures occur when a bone or bone fragment breaks through the skin or
the skin and bone are broken in a traumatic, crushing injury. Proper treatment
for open fractures must also include concern for possible infection.

Recognizing Fractures:

An open fracture will typically be self evident due to the exposed bone. The
following clues suggest you are dealing with a probable closed fracture:

The victim felt a bone break or heard a "snap".

The victim feels a grating sensation when he/she moves a limb. (This
condition is known as crepitus.)

One limb appears to be a different length, shape or size than the other,
or is improperly angulated.

Reddening of the skin around a fracture may appear shortly after the fall.

The patient may not be able to move a limb or part of a limb (e.g., the
arm, but not the fingers), or to do so produces intense pain.

Loss of a pulse at the end of the extremity.

Loss of sensation at the end of the extremity.

Numbness or tingling sensations.

Involuntary muscle spasms.

Other unusual pain, such as intense pain in the rib cage when a victim takes a deep breath or coughs.

If you discover any of these symptoms and cannot attribute them to any other
obvious cause, assume them to be a fracture.

Initial Care for Fractures

In treating fractures, an unhurried and careful approach is best. Few
fractures are life threatening unless mishandled. Check the patient for any more
serious injuries. Make sure someone is going for help, or call 911. Ensure
your patient is breathing and that excessive bleeding is controlled and that all
open wounds are protected as best you can from contamination. After these
elements are satisfied you can deal with stabilization of the fracture.

If you can, carefully cut away all clothing near the fracture site. You need
to make sure the fracture hasn't broken the skin and you may be able to use the
cut away material to aid in splinting. If you find an open fracture, protect the
wound from contamination as you would any other.

No matter how soon you expect to get medical help, you should immobilize all
fractures to prevent additional injuries due to accidental movement or muscle
spasms. Immobilization can be achieved many ways; the key points being not to
worsen the situation while immobilizing and making sure to also immobilize the
joints above and below any limb fracture.

DO NOT try to straighten angulations of a bent wrist, ankle or shoulder or
attempt to straighten any dislocated joint!

When splinting using sticks or other "found" objects, try to make
padding between the injured limb and splint using a jacket, shirt filled with
grass, anything which can be reasonably secured and can help fill in the gaps
between the limb and the splint material. Don't get carried away with this
concept, but if you can handily make something up without delaying the splinting
process, it will be more comfortable to the patient.

It is not always possible to tell with the naked eye if a bone has been
fractured. In case of doubt, it is best to assume the victim has received a
fracture and treat it accordingly.

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